Patient-Provider Communication and Benefit Finding in Older Cancer Patients

Background: Good communication between medical providers and cancer patients plays a critical role in ensuring quality cancer care. Skilled patient-provider communication is associated with better treatment decisions, greater adherence, fewer unwanted medical interventions, and improved health outcomes. As such, patient-provider communication has become a central target for achieving healthcare’s Triple Aim of improving population health and patient experience, while decreasing costs. Provider communication may also be associated with positive coping and post-traumatic growth in cancer patients. According to the medical literature older adults have distinct communication needs that studies indicate are not often met by healthcare providers. This analysis of a nationally representative dataset of the experiences of cancer survivors examined the relationship between patient age and the experience of post-traumatic growth (i.e., benefit finding), and whether this relationship was mediated by the depth and quality of clinical communication (operationalized as discussion of a) follow-up procedures; b) side-effects of treatment; c) emotional and social needs; and d) lifestyle factors).   

Methods: We conducted a secondary analysis of the 2011 Medical Expenditures Panel Survey (MEPS) Experiences with Cancer Survivorship Supplement developed by the Agency for Healthcare Research and Quality, National Cancer Institute, American Cancer Society and LIVESTRONG.  The cross-sectional data (n=1319) were analyzed using multivariate regression models to examine the effects of a) patient age on benefit finding, b) depth of clinical communication on benefit finding and c) patient age on depth of clinical communication. A Sobel test of mediation was conducted to examine whether the effect of age on benefit finding was mediated by the depth of clinical communication.

Results: Patient age was negatively associated with both depth of clinical communication (B=-.591, p<.01) and benefit finding (B= -.248, p<.05) when controlling for gender, income, education, race, and objective cancer stress. When testing for mediation, clinical communication was found to be positively associated with benefit finding (Beta = .208, p<.01). Results of the Sobel test indicate that the total effect of age on benefit finding could be mediated (Z=-2.87, p<.01) by the depth of clinical communication such that 34.57% of total effect of age on benefit finding was mediated by communication.

Implications: Findings of this study are consistent with evidence that older adults with cancer have considerable unmet informational needs and that attentive clinical communication may enhance psychological adaptation to cancer. In the absence of adequate clinical communication, older adults may not experience the opportunities for benefit finding that younger cancer patients are afforded. Providers are under increasing pressure to limit time spent with patients, undermining the depth and quality of clinical communication. Social workers in medical and integrated settings should be aware of the informational needs of older adults and be prepared to provide needed information, communication and shared decision making support to this vulnerable and growing population.